Psychiatric health needs and services before and after complete deinstitutionalization of people with intellectual disability.
Deinstitutionalization backfires when community psychiatric care is missing.
01Research in Context
What this study did
Feldman et al. (1999) tracked adults with intellectual disability before and after Norway closed every large institution.
They compared behavior records and psychiatrist visits in the last institutional year to the first community-only year.
No control group existed; the nation served as its own baseline.
What they found
After the doors shut, behavioral incidents rose and visits to trained psychiatrists fell.
Adults who had relied on on-site specialists now struggled to find any.
How this fits with other research
Navas et al. (2025) saw the opposite: adults moving to community homes gained very-large quality-of-life jumps. The gap is timing and support. Norway’s 1999 closure sent people to generic services; the 2025 moves included ongoing choice-making supports.
Lulinski et al. (2021) explains who boomerangs back: people with psychiatric labels, short prior stays, and large group homes—exactly the group A et al. found losing help.
K-Reid et al. (2005) and Cannella et al. (2006) echo the warning. Swedish adults still had undiagnosed disorders, while a UK integrated team cut symptoms once it bridged ID and mental-health staff.
Why it matters
Closing a building is not a treatment plan. If you help clients transition, lock in psychiatric appointments, smaller homes, and integrated teams first. Map local ID-trained prescribers before day one in the community and write those names into the ISP.
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02At a glance
03Original abstract
Before total deinstitutionalization in Norway, many believed that the ordinary health care system could give people with intellectual disability the same or even better health care than that which they received in institutions. It was said that institutions created psychiatric problems, and that these would diminish or even disappear with the closing of these establishments. The present study is a prospective cohort study without a control group. It examines the frequency of mental health problems and the psychiatric health services which 109 subjects aged between 16 and 65 years received before (1987) and after (1995) deinstitutionalization. Mental health problems were defined as behavioural disturbances, and psychiatric disorders and symptoms. Psychiatric disorders were identified with the Psychopathology Instruments for Mentally Retarded Adults (PIMRA), which were filled in by the carers. Behaviour disturbances were identified as having occurred or not during the previous year. Psychiatric problems remained frequent, and there was a significant increase in behavioural problems in spite of total deinstitutionalization and improved physical living conditions. Access to qualified help, such as psychologists and psychiatrists, had been substantially reduced. Most mental health problems among people with intellectual disability are not solved by reorganization or deinstitutionalization, and such measures are no substitution for professional assistance.
Journal of intellectual disability research : JIDR, 1999 · doi:10.1046/j.1365-2788.1999.00236.x